STIs, Teens, and Doctors

Unfortunately, with the rise of abstinence-only education, many teens do not get adequate or accurate information about safer sex and STIs in school, and recent research shows that they may not get it from their health care providers, either. One study, for example, found that, of the doctors surveyed, less than one quarter appropriately screened their young, sexually active women patients for STIs.

The good news is that some in the health care field are working hard to promote better knowledge and communication about sex and STIs — for doctors and patients, alike.

Bad Medicine?

In a study published in the journal Sexually Transmitted Diseases, Dr. Harold C. Wiesenfeld found that, on average, primary care doctors correctly answered only 71 percent of questions about STI diagnosis and treatment. What's more, specialists — including ob-gyns — fared no better that general practitioners.

"Given the state of the [STI] epidemic in the United States, it's inexcusable that some women are receiving sub-par care," says Wiesenfeld. "We should be getting better and recognizing that we have a problem."

One reason doctors may lack adequate information about STIs is that their ongoing medical training isn't required to address it. While all doctors are required to take a certain number of hours in continuing medical education (CME) classes each year, there is no requirement as to the topic content of the courses, even for specialist like ob-gyns.

"If you're an ob-gyn, you could do your 100 [CME] hours in cancer, and have no clue about STDs," Wiesenfeld says.

In addition, some doctors who do have the proper knowledge may feel uncomfortable discussing sex and STIs with younger patients. Others may falsely assume that their teen patients — some of whom they may have known since birth — are not at risk, and omit information about sex and STIs because of that assumption.

"Doctors tend to assume that their own patients are less at risk, so they discuss sex and STIs less than they should," says Julie S. Downs, director of the Center for Risk Perception and Communication at Carnegie Mellon University and lead author of a study on adolescent girls and STIs published in the Journal of Adolescent Health. Downs found that adolescents and teen girls appear to learn about STIs after they had gotten them — too late for prevention.

"People are embarrassed to talk about [sex and STIs]," says Downs. "The less useful information there is, the less people are going to be able to make sensible decisions."

Research has shown that when doctors are reluctant to talk to their patients about STIs, young patients are less comfortable with asking questions. Lack of information about STIs is associated with inconsistent condom use, delays in STI treatment, and lack of follow-up care.

Talk Therapy

The silence around sex and STIs has a powerful effect. Indeed, it may seem like a never-ending cycle: doctors are reluctant to discuss sex and sexuality with their teen patients; patients, in turn, are hesitant to ask questions if their providers don't bring up the subject; and if a teen doesn't bring up the subject of sex or STIs, the doctor may not grasp the need to discuss it.

In order to break the cycle, doctors or patients — or both — need to speak up.

Research has shown that when doctors discuss STIs with young patients, those patients are less likely to engage in risky behavior. Not only that, the more proactive doctors are in discussing sexual health with their young patients, the more likely it is that their patients will feel comfortable talking to their doctors about sexual problems they might experience in the future.

Patients can also play a role by becoming their own advocates and take the lead by asking for the information they want and need. The asking itself may be all that is necessary.

"Doctors do have better information than teenagers do," says Downs, "so [patients] actually asking doctors for that information might be a good impetus for doctors to realize that they should be giving that information out."

Conquering Embarrassment

For Downs, embarrassment is central to the problem of poor information about sex and STIs. "I think the shame that surrounds sex in our society leads to a lot less discussion about it," she says. "Teenagers are in a very difficult position."

To help conquer embarrassment, Downs has put her efforts toward educating patients. Her interactive DVD, What Could You Do? educates young women about STIs and sexual decision-making.

However, some health care providers may not be open to talking about sex, sexual health, and STIs — not only with teens, but with adults as well. If your provider doesn't answer your questions to your satisfaction, evades them, or seems very uncomfortable, it may be time to look for a new provider who can be open and honest with you. Planned Parenthood has health centers across the country with health care providers who are trained to provide clients with the most up-to-date information about prevention, testing, and treatment of STIs.

Teens who are concerned about confidentiality may want to ask their health care providers about their policies before making an appointment. Planned Parenthood health centers strive to provide services that are confidential and affordable, especially for teens. But for one reason or another, health centers in certain locations may not be able to guarantee complete confidentiality. To find out about the Planned Parenthood health center near you, call 1-800-230-PLAN.